DOI: https://doi.org/10.53350/pjmhs22161639 ORIGINAL ARTICLE P J M H S Vol. 16, No.01, JAN 2022 639 Arthroscopic Repair of Large and Massive Tears in Rotator Cuff and its Consequences: a Longitudinal Retrospective Analysis Conducted in a Retrospective Manner AKBAR ALI 1 , BASIT MUKHTAR 2 , ARSALAN RIAZ 3 , MUHAMMAD FARHAN FARHAT 4 , SAYED NAJMUL HASSAN 5 , ASFANDYAR KHAN 6 1 Post Graduate Resident Orthopaedics, Shaheed Zulifqar Ali Bhutto Medical University/PIMS Islamabad Pakistan. 2 Post Graduate Resident Orthopaedics, Pakistan Institute of Medical Sciences Islamabad, Pakistan. 3 Medical Officer Orthopaedics, Federal Government Polyclinic Islamabad, Pakistan. 4 Medical Officer Orthopaedics, Pakistan Institute of Medical Sciences Islamabad, Pakistan. 5 District Specialist Orthopaedics, Type C Hospital Ghazi Harripor, Pakistan. 6 Assistant professor Orthopaedics, Pakistan Institute of Medical Sciences (PIMS) Islamabad. Corresponding author: Akbar Ali, Email: pims72@yahoo.com ABSTRACT Aim: Assessment of the consequences of arthroscopic repair of large and massive rotator cuffs. Study design: Retrospective analysis Place and duration: This study was conducted at Shaheed Zulifqar Ali Bhutto Medical University/PIMS Islamabad Pakistan from August 2020 to August 2021. Methodology: In the current study, 50 patients were included out of which 37 patients had large tears and 13 had massive tears which were repaired arthroscopically. Average follow up was of 32 months. Modified UCLA shoulder rating scale was used to evaluate the function, strength, range of motion and the pain before and after surgery. Results: Among the included 50 patients, 21 patients were female, and 29 were male. The range of their ages was between 41 and 76 years. The dominant extremity was affected in majority of patients. The average preoperative time of patients was 10 months. According to UCLA, 98% patients experienced satisfactory results, and only 1 patient had to undergo second surgery for the repair. Conclusion: The study concluded that arthroscopic repair of tears in rotator cuffs is the best technique which can be used for repairing large and massive tears in rotator cuff. Keywords: tears, outcome, arthroscopy, rotator cuff INTRODUCTION To keep the shoulder functioning properly, the muscles of rotator cuff play a very critical role which is why tears in rotator cuff cause severe shoulder pain and often a reason of disability. 1 In 1911, Codman conducted a surgical procedure for the first time to repair the full thickness tear in the tendon of rotator cuff. Since then it has been a topic of debate that whether the tears in the rotator cuff should be treated by surgical management or non-surgical management. 2 The debate was intensified when the idea of optimally treating the rotator cuff tears was developed. It was recommended by some surgeons that arthroscopy should not be the preferred method of treatment for treating the large and massive tears and an open approach should be used. 3 However, in opting the open approach, one can encounter certain issues such as attaining the proper mobilization, and recognizing the patterns of tear in the rotator cuff. 4 Whereas, the chronicity of tears and tear mobilization are the positive aspects of opting the arthroscopic techniques but due to certain advantages, some people still prefer simple decompression and debridement for the massive tears. 5 This study was conducted in a retrospective manner to assess the outcomes of patients who had large massive tears in tendons of the rotator cuff and were treated with the arthroscopic repair and decompression. METHODOLOGY The current study was a retrospective analysis which included 50 patients who had massive and large tears in the tendons of rotator cuff. Ethical review committee of the institute provided the permission to conduct this study. These tears in their rotator cuff were repaired arthroscopically. Defects or lesions in the cuff ranging from 3-5 cm at least 3 cm in length and width should be the minimum tear size in between at least two or more than two planes were considered as large tears whereas massive tears were defined as lesions which are greater than 5 cm in measurements. All the tendon ligaments must be ruptured till the glenoid. The inclusion criteria consisted of patients who had massive or large rotator cuff tears and were repaired completely by the arthroscopic technique and had a follow up of at least 12 months. Arthroscopic repair of the tear was assessed by the capability of tissue to hold the stitches and appropriately mobilizing the cuff till the tuberosity. It was also made sure that all these patients must have experienced distal clavicle excision and arthroscopic sub acromial decompression. Distal clavicle excision was routinely performed on every patient to get rid of the pain that could arise from a secondary source. The patients were treated conservatively which included physical therapy for at least 1 month (minimum for 3-6 months), anti-inflammatory medicines, symptomatic treatment via activity modification, and sub acromial injection of steroids. When non operative management, functional impairment, and extreme pain was observed continuously, surgery was performed. Pre and postoperative shoulder pain along with range of motion, strength, and function was evaluated by a modified UCLA shoulder rating scale. The maximum score observed was